Staging and pathological grading systems are useful, but imperfect systems for predicting recurrence in patients with HNSCC. Molecular classification of HNSCCs is required to obtain prognostic as well as mechanistic information to improve patient care and outcomes. When normal cells are exposed to environmental carcinogens (e.g., chemical carcinogens and oncogenic viruses), DNA methyltransferase (DNMT) catalyzes enhances DNA methylation. Elevated levels of 5mC at tumor suppressor gene (TSG) promoters lead to TSG silencing and functional inactivation, ultimately contributing to tumor initiation or progression. Loss of TET (Ten-eleven translocation) activation through promoter methylation occurs in tumor cells, successively increasing the 5mC levels and promoting TSG inactivation. Enzymes of the TET family catalyze stepwise oxidation of 5mC in DNA to 5hmC and further oxidation products, not only generating new epigenetic markers but also triggering active or passive demethylation pathways.

HPV-related oropharyngeal carcinomas belong to an independent tumor type with regard to the cellular, biological, and clinical features. The HPV status, smoking status, tumor stage, and lymph node status are important factors that can be used to classify patients with low-, intermediate-, and high-risk of death. However, the optimal classification for patients with low-, intermediate-, and high-risk disease remains to be determined. Our findings support the use of methylation markers in patient selection for adjuvant therapy following primary treatment by surgery and oropharyngeal cancer surveillance programs.

Recently, the potential usefulness of cfDNA as a biomarker was shown. Liquid biopsy utilizing tumor DNA in the circulating blood could address many limitations of tissue biopsies, while also opening up innovative paradigms in cancer care. Analyses using DNA methylation-based strategies for detection of cfDNA have suggested that such approaches may pave the way for new advances for early cancer diagnosis.

No standard treatment has been established yet for acoustic trauma (AT). The most commonly used treatment is systemic steroid therapy, according to the treatment guideline for acute sensorineural hearing loss. Here in, we report eight cases of AT that received systemic steroid therapy within 24 hours after acoustic overexposure. The subjects included 19- to 22-year-old military school students with AT induced by gunshots during training sessions. Seven of the eight patients had hearing loss, and one patient had only tinnitus without hearing loss. After systemic steroid therapy initiated within 24 hours of the onset of AT, the hearing thresholds recoverd completely in six of the seven (86%) patients with hearing loss, and significantly in the remaining one (14%) patient. Our therapeutic success rate for AT in this study was markedly higher than previously reported success rates. Our results strongly suggest that early steroid treatment is important to obtain significant therapeutic effect in patients with AT, as previously reported in the field of basic research.

Two rare cases of toxic shock syndrome (TSS) that developed after ear surgery are reported in this paper. The first patient was a 44-year-old man who presented with the complaint of left ear fullness and diagnosed as having a cholesterol granuloma. Since placement of a subannular tube in his left ear drum proved ineffective, canal-down tympanoplasty was performed. Ten days after the surgery, the patient developed high fever. On the 12th postoperative day, he developed diffuse erythroderma and hypotension with a systolic blood pressure of less than 90 mmHg, liver failure, and thrombocytopenia. On the 14th postoperative day, he developed shock and respiratory failure caused by acute respiratory distress syndrome (ARDS), and was initiated on mechanical ventilation. On the 15th postoperative day, culture of the ear discharge grew methicillin-resistant Staphylococcus aureus (MRSA). Subsequently, the patient developed disseminated intravascular coagulation and renal failure, and was initiated on hemodialysis. He received adequate hydration, appropriate antibiotic therapy, and γ-globulin administration. On the 24th postoperative day, improvement of both the respiratory failure and renal insufficiency was noted.

The second patient was a 72-year-old man with uncontrolled diabetes mellitus who presented with the complaints of right otalgia and otorrhea. He was diagnosed as having cholesteatoma in the external auditory canal, and treated by canal-down tympanoplasty. Two days after the surgery, he developed a high fever. On the 5th postoperative day, culture of the ear discharge grew MRSA, and laboratory examination revealed thrombocytopenia. On the 6th postoperative day, he developed respiratory failure, and was diagnosed as having ARDS. On the 13th postoperative day, the respiratory failure reached a terminal stage, but administration of prednisolone (60 mg/day) proved effective. The patient received adequate hydration and appropriate antibiotic treatment. On the 24th postoperative day, his respiratory failure improved.

These two cases are probably the first cases of TSS after ear surgery reported in Japan. Since the frequency of TSS after ear surgery is likely to increase, otologic surgeons should be aware of the manifestations of TSS.

Surgery for tympanic membrane lateralization is often challenging. There is no established treatment for the condition, and only a few studies have reported the long-term hearing outcomes after treatment.

We studied the effects of tympanoplasty using a long ossicular prosthesis developed by Shinkawa et al. in seven ears with severe lateralization of the tympanic membrane.

We enrolled seven ears of seven patients with severe lateralization of the tympanic membrane who had undergone surgery to improve hearing from January 2016 to December 2017 and had been followed-up for at least 1 year. In all seven (100%) ears, the surgery had been the second operation and resulted in short-term hearing improvement at 6 months postoperatively, suggesting good effectiveness of the surgical technique.

However, long-term hearing improvement at 1 year after surgery was observed in only five out of the seven ears (71.4%), and in fact, hearing loss was observed in some cases. There is a need to address the stability of a long ossicular prosthesis and prevent reduction in the sound transmission efficiency caused by contact between the prosthesis and the posterior wall of the external auditory canal due to new bone formation.

Since revision surgery for tympanic membrane lateralization is difficult, adequate surgical skills should be acquired to prevent lateralization of the tympanic membrane during the initial surgery.

Amyloidosis is a disease characterized by dysfunction of various organs caused by the deposition of amyloid fibrils, and is classified as systemic or localized amyloidosis. We present a rare case of localized amyloidosis of the external auditory canals. An 83-year-old man complaining of an abnormal sensation in both ears was referred to our hospital. He had the habit of rubbing his ears with cotton swabs. Examination revealed several small nodules in the external auditory canals bilaterally, and biopsy of the nodules suggested the diagnosis of amyloidosis. Surgical resection of the nodules was performed under general anesthesia. Immunohistochemical studies revealed positive immunoreactivity of the amyloid deposits for immunoglobulin light chains. As whole-body examination showed no evidence of systemic amyloidosis, the patient was diagnosed as having localized amyloidosis of the external auditory canals. No recurrence was observed for a year after the resection and the patient is under long-term follow-up.

Previous reports have suggested that chronic stimulation and inflammation of the external auditory canal can trigger the development of amyloidosis. The patient has been instructed on the importance of breaking the habit of rubbing his ears.

We report the case of a male patient with Osler-Weber-Rendu disease who died of chronic heart failure that was exacerbated by anemia secondary to epistaxis. He had suffered from repeated episodes of epistaxis from approximately 20 years of age. Subsequently, he developed atrial fibrillation and mitral valve insufficiency and underwent mitral valve replacement at the age of 60 years. Postoperatively, he was prescribed anticoagulants, which increased the frequency of epistaxis and the amount of bleeding. At 64 years of age, he was hospitalized with heart failure and received a blood transfusion for the first time. He subsequently underwent vascular embolization of both maxillary arteries, but the epistaxis persisted. His epistaxis increased further in severity and the heart failure began to worsen from approximately 68 years of age. He suffered from massive epistaxis daily, but surgical treatment, such as nostril closure surgery, was not possible because of the severe heart failure. After nasal insertion of a silicon cannula, however, the volume of epistaxis decreased remarkably. Thus, in our patient, nasal insertion of a silicon cannula was useful for controlling epistaxis.

Sarcoidosis is a systemic disease of unknown cause that is characterized histopathologically by the formation of noncaseating epithelioid granulomas. The disease most commonly involves the lungs and skin, and rarely affects the nasal cavity. We report two cases of patients with chronic lacrimal cystitis apparently secondary to nasolacrimal duct obstruction caused by nasal sarcoidosis. Endoscopic dacryocystorhinostomy (EN-DCR) was performed in both patients. Case 1 was a 44-year-old woman with pulmonary and cutaneous sarcoidosis. She presented with the chief complaint of right-sided epiphora, and was treated by right EN-DCR. One year later, she presented with left-sided epiphora, and underwent left EN-DCR. Case 2 was a 48-year-old woman with pulmonary and cardiac sarcoidosis. She presented with the cheif complaint of bilateral epiphora, and was treated by bilateral EN-DCR. In both cases, histopathological examination of the nasal mucosa at the opening of the nasolacrimal duct revealed noncaseating granulomas, suggestive of sarcoidosis. On the other hand, histopathological examination of the lacrimal sac mucosa did not reveal anu features of sarcoidosis, suggesting that the lacrimal cystitis may have been secondary to nasolacrimal duct obstruction caused by nasal sarcoidosis. While the postoperative course was uneventful in both cases, we propose to keep them under careful follow-up because of the propensity of nasal sarcoidosis for recurrence.

[Introduction] Cranial nerve palsies can occur as a complication of several diseases, such as diabetes mellitus, aneurysm, and sinusitis. We have encountered many cases in which we successfully identified the cause of the cranial nerve palsy, but later also found an additional etiologic factor. Thus, even in a patient with sinusitis developing a cranial nerve palsy, the palsy could be caused by a disease other than sinusitis.

[Case] A 53-year-old man with diabetes mellitus receiving insulin therapy visited an ophthalmologist with a several day’s history of diplopia. He was diagnosed as having left abducens nerve palsy, and imaging examination revealed sinus lesions, so that he was referred to our otorhinolaryngology department. Paranasal sinus computed tomography showed left pan-sinusitis and a high-density area in the sphenoid sinus. He was admitted to the hospital with a diagnosis of abducens nerve palsy complicating bacterial or fungal sinusitis. He was initiated on treatment with antibiotics, but the symptoms persisted. Subsequently, he underwent left endoscopic sinus surgery. Inflammatory polyps and purulent nasal discharge were found in the left paranasal sinuses. There were no fungal lesions or bone defects. We opened and cleaned all the paranasal sinuses. As his diabetes mellitus was poorly controlled (HbA1c 11%), we did not initiate the patient on steroid therapy. The mucosa of the sinuses returned to normal soon after the surgery, and the abducens nerve palsy improved by 3 months after the surgery.

[Conclusion] The patient’s left abducens nerve palsy could have been caused by the acute sinusitis, but it could also be attributable to diabetic ophthalmoplegia. In a case of sinusitis developing cranial nerve palsy, we should bear in mind that various diseases other than sinusitis could also cause cranial nerve palsy.

Endoscopic nasal or paranasal sinus surgery is sometimes necessary in children. We reviewed 21 pediatric cases of endoscopic surgery in our department: 10 cases of antrochoanal polyp, 4 cases of blowout fracture, 2 cases of chronic rhinosinusitis with polyposis, and 5 others. The patients consisted of 9 boys and 12 girls, and their average age at the time of surgery was 8.8 years old. All surgeries were performed under general anesthesia and with a 2.7-mm or 4.0-mm rigid endoscope. One case of sphenoid sinus antrochoanal polyp in a girl required revision surgery; simple resection was performed at 3 years of age and again at 5 years of age. Functional endoscopic sinus surgery was performed in an 11-year-old boy and a 14-year-old boy with chronic rhinosinusitis. Their pathology was suspected of being type 2 inflammation in addition to sinobronchitis syndrome, and their sinusitis recurred early after surgery. Although paranasal sinus surgery is uncommon in children, whenever indications are present, it is necessary to tailor the surgical procedure to the individual in view of the patient’s age and growth status. If radical surgery is contraindicated because of the patient’s age, it is important to formulate a long-term treatment strategy at the time of the initial surgery.

Patients with a deep cervical abscess sometimes show a serious course and require immediate surgical intervention. The main underlying causes if a deep cervical abscess are peritonsillar abscess, upper respiratory tract infection with acute tonsillitis, and dental infections; on the other hand, it can also, rarely, occur as a complication of medical procedures such as upper gastrointestinal endoscopic examination.

The risk of perforation associated with upper gastrointestinal endoscopic examination is estimated to be 0.004% to 0.007%.

While some cases of deep cervical abscess, especially those in which the condition is recognized early, can be cured by conservative treatment, others, especially those in which the condition is not detected sufficiently early, may require surgery.

We report a case of deep cervical abscess that occurred as a complication of upper gastrointestinal endoscopic examination.

The patient was a 71-year-old man, who complained of a boggy feeling in the right neck during upper gastrointestinal endoscopic examination, and then developed right neck pain and high fever (40C°) on the night of the examination. Since the symptoms did not improve, he visited our hospital on the 3rd day after the examination and was admitted. On the 3rd day of hospitalization, an emergency drainage was performed by external incision for a deep cervical abscess. In this case, the deep cervical abscess developed after upper gastrointestinal endoscopy and could be improved by external incision and drainage, but it was difficult to determine that the cervical abscess developed as a complication of perforation caused during gastrointestinal endoscopic examination.

It is important to determine the route of infection through history taking.

Maxillofacial pain is one of the major symptoms of temporomandibular disorders, and bruxism is considered as one of the main causes of temporomandibular disorders. Pathological factors such as stress are thought to increase the incidence of bruxism, and consequently, of temporomandibular disorders. We report two cases in which yokukansan was effective for control of the maxillofacial pain, which was thought to be caused by stress-related sleep bruxism.

Case 1 was a 35-year-old woman who was often stressed by her family and work pressures, and was sometimes told that she exhibited sleep bruxism. She reported to our department with a 6-month history of right mandibular pain. Since the symptom was induced by palpation of the right masseter muscle and was particularly severe in the morning, we diagnosed the pain as arising from the fascia of the masseter muscle due to sleep bruxism. We started her on treatment with yokukansan (7.5 g/day), and the mandibular pain improved by the end of 4 weeks of treatment.

Case 2 was a 53-year-old man who experienced severe stress at work. When he woke up during sleep, he often clenched his teeth. He reported to our department with a one-year history of discomfort and mild pain in the back of ears, temporal region and around the eyes on both sides. Since the symptom was induced by palpation of the sternocleidomastoid muscle and was particularly severe in the morning, we diagnosed the pain as arising from the fascia of the sternocleidomastoid muscle due to sleep bruxism. We started him on treatment with yokukansan (7.5 g/day), and the symptoms improved by the end of 6 weeks of treatment.

Yokukansan is expected to reduce bruxism due to its anti-stress effect and efficacy in reducing chronic pain itself, and is considered to be useful for cases of chronic maxillofacial pain associated with bruxism.

This study was conducted to examine the postoperative symptoms of patients with cervical sympathetic chain schwannoma, which are difficult to monitor during surgery, as well as the condition and postoperative symptoms of patients with these tumors who present with neurological deficits prior to surgery. The study population consisted of 20 patients who had undergone inter-capsular resection for cervical sympathetic chain schwannoma at our center between 2005 and 2020. We conducted a retrospective review of the age, sex, maximum tumor diameter, tumor position (upper neck type, middle neck type, lower neck type), preoperative neurological deficits, and postoperative neurological deficits in the patients.

Our results showed that 4 out of the 7 patients with upper- and lower-neck type tumors presented with preoperative neurological deficits, and that these patients were more likely, as compared to patients with middle-neck type tumors, to exhibit preoperative neurological deficits (p<0.01). Patients who presented with preoperative neurological deficits were unlikely to show improvement after the surgery, whereas the incidence of permanent paralysis after surgery was 25% in patients without preoperative neurological deficits. Therefore, we speculated that the risk of irreversible neurological deficits is higher in patients with tumors located in the upper or lower neck, which are the sites of compression of hard tissue.

Introduction: At our department, peripherally inserted central venous catheters (PICCs) are considered as the devices of first choice for central venous access. The aim of this study was to clarify the safety and usefulness of PICCs for patients with head and neck disease.

Materials and Methods: Data of a total of 87 patients with head and neck disease who had undergone PICC insertion were analyzed, and the success rate of PICC insertion, the insertion time, and the catheter-related immediate and delayed complications were investigated.

Results: Our investigation revealed a success rate of 100% and a median catheter insertion time of 27.2 minutes. Catheter-related immediate complications included subcutaneous haematoma (2) and internal jugular venous invasion (1), and the catheter-related delayed complications included accidental removal (9), PICC blockage (7), bleeding and subcutaneous haematoma formation (5), catheter-related bloodstream infection (2), PICC damage (2), and venous thrombosis (1).

Conclusion: PICC is a safe and useful device for patients with head and neck disease.